Feature story

Standing up to cancer by spreading the net

A radical new approach in the battle against the Big C aims to create multiple institutions that can deliver high quality and affordable care to patients across India

Cancer is a disease dreaded more than others, not just because it is life threatening but also because fighting it can be exhausting as well as expensive. Is it possible to change this terrifying equation? That’s the question the Tata Trusts are looking to answer through a novel cancer care initiative currently being rolled out in Assam and one that could be replicated across other states in the future.

The attempt is to change the landscape and the timeline on how cancer is detected and treated in India. The Trusts are working to reduce the bogey aspect of the disease by increasing the number of cancer care facilities and clinicians and by promoting better screening processes. The objective is to catch cancer early and treat it with the best of care.

The crying need is for a radical approach to cancer care and treatment, and the model the Trusts are working on has been termed ‘distributed care’. Simply put, this translates into splitting up the detection, diagnosis and treatment stages of the disease.

What happens now is that the majority of cancer cases in India are not detected early. When it is finally found out, the patient has to, typically, leave home, travel hundreds of kilometres to a good hospital, and stay there for weeks or months until the chemotherapy or radiation treatment is completed. Jobs and livelihoods get affected and there is a huge burden that gets added to the treatment cost.

“We wanted to change the journey of the cancer patient,” says Prakash Nataraj, who leads operations in the initiative. The vision is to reduce the number of stage 3 and 4 patients — those with advanced cancer conditions — who account for 70% of Indians coping with the disease. “We hope to bring this figure down to 30% over the next five years.”

The need for more

Mr Nataraj cites the Tata Memorial Hospital (TMH) in Mumbai and the Tata Medical Center in Kolkata to explain why such institutions, outstanding as they are, will not suffice for India’s numerous cancer patients. “A few thousand beds and oncologists will not be able to handle the large numbers,” he points out.

In the distributed care framework, cancer care and treatment are ‘disaggregated’ through the setting up of a network of level 1, 2 and 3 facilities. A level 1 facility is a specialised cancer hospital on the lines of TMH or the Regional Cancer Centre in Thiruvananthapuram, where the mandate is research and education and the handling of complicated cases.

Level 2 facilities are superspecialty units next to government medical colleges with full-fledged cancer care equipment and oncologists. Here is where the patient’s initial treatment plan will be formulated and started. For regular treatment, the patient can approach a level 3 facility. These day-care centres — adjoining district hospitals — will be closer to the patient’s home and can provide the appropriate treatment.

“More than 90% of cancer cases will be handled at level 2 and 3 facilities,” says Anurag Gupta, who heads projects in the Cancer initiative. “Patients can get a diagnosis and treatment plan at the district level, without having to uproot their lives and travel long distances. Only complex cases should go to a level 1 centre.” The Trusts hope that this approach will bring down the cost of treatment, for a majority of patients, to a fraction of what it is at present.

An important component of the distributed care model is that cancer sufferers need not travel long distances to access quality care. TMH in Mumbai, for example, sees an influx of some 60,000 patients every year, of which a third come from afar.

In Assam, the distributed care model will have 19 modern facilities spread across several districts. The Trusts have, in partnership with the Assam government, established the Assam Cancer Care Foundation to manage this set up, under which 17 new centres (of the 19) will come up. Screening protocols for early detection and promoting community awareness of government support schemes for patients are part of the agenda here.

The Assam network — the first of its kind in the world — is coming up in a staggered manner and will start functioning from mid-2019. The model has already sparked plenty of interest from other states. Odisha, Nagaland, Telangana, Jharkhand and Bihar are in talks with the Trusts to replicate the framework, while Kerala, Maharashtra and Karnataka have roped them in to play an advisory role.

The distributed care model is a vital piece in the Tata Trusts’ cancer treatment thrust, and there’s more on their plate. In Tirupati in Andhra Pradesh, the Trusts have started work on a 300-bed cancer-care facility in partnership with the Tirumala Tirupati Devasthanams. The Trusts are also planning to build 250-bed level 1 centres in Bhubaneshwar, Ranchi and Hyderabad.

Besides these initiatives, the Trusts are in talks with private and charitable hospitals in Navsari, Allahabad, Mangalore, Mathura and many other Indian cities to extend India’s cancer treatment reach. “We are engaging differently with each partner, depending upon what support they are looking for,” says Mr Gupta.

A 3D image of the Mahamana Pandit Madan Mohan Malaviya Cancer Center

Varanasi gets specialty cancer care

T he Tata Trusts have established two apex cancer care and treatment centres in Varanasi, the historical city best known as one of Hinduism’s holiest centres. These two ‘level-1 hospitals’ will serve as centres of excellence in cancer care for Uttar Pradesh, the state where Varanasi is located.

One of the two institutions is the Homi Bhabha Cancer Hospital, earlier known as the Indian Railways Cancer Institute. Developed as a brownfield project, the Trusts took about eight months to upgrade the existing structure into a 180-bed hospital. It reopened in May 2018.

The second is a greenfield cancer-care facility built by the Trusts in the Banaras Hindu University campus. Named the Mahamana Pandit Madan Mohan Malaviya Cancer Center, the 352-bed hospital, inaugurated on February 8, 2019, was built in 10 months, record time for such a facility.

The 586,000-sq ft centre will offer medical, surgical and radiation oncology treatments, including nuclear medicine. It will be the biggest cancer facility in the region, with a wide range of equipment. The Trusts have been closely involved in the design, funding and building of the two hospitals, both of which will be staffed and operated by the Tata Memorial Hospital, Mumbai.

Common to all these centres will be the assurance of quality standards for cancer care. They will follow protocols set down by the National Cancer Grid, a network of cancer centres, research institutes, patient groups and charitable institutions where the Tata Trusts play an advocacy role.

The task of setting up large networks of new cancer facilities across the country is huge and challenging. “We are sailing in uncharted waters; this has never been attempted before,” says Mr Nataraj. One of the bigger challenges is the shortage of trained clinicians in India to handle the heavy load of cases.

Training gains traction

To tackle this load, the Trusts are putting together a cadre of well-trained medical personnel. The Trusts are driving a training programme that provides intensive training to postgraduate-level clinicians. These doctors will be able to detect and treat the first wave of patients. “The intent is to reduce the load and waiting period at level 1 facilities today, as well as to give patients a better shot at early treatment,” says Mr Gupta.

A distributed cancer care model requires strong technology support. There will be a ‘national command centre’ to deliver call centre support to patients and diagnostic consultancy to the cancer centres. Tata Consultancy Services’ ‘digital nerve centre’ will be harnessed to enable the command structure. The command centre will also generate a huge amount of data that can help India in its battle against cancer.

Cancer screening is another crucial bit in the Tata Trusts approach. To this end, the Trusts are driving cancer screening processes in several Indian states through a variety of programmes. They are active as well at the other end of the cancer care spectrum: palliative care and family counselling services are a component of the Trusts’ cancer care model.

It seems an onerous responsibility for a single institution to take on all of this. But that’s how the challenges posed by the disease show up and the Trusts certainly have the commitment to last the course.

A cadre of well-trained medical personnel and cutting-edge technological solutions are at the core of the cancer care model being rolled out